Epidemiology and Etiology of Primary Groin Hernias

Abstract

The population prevalence (the percentage of a population being studied that is affected with a particular disease at any given time) and the incidence (the rate of occurrence of new cases of a particular disease in a population being studied) of groin hernias have been studied extensively by a variety of authors in the last 100 years [1]. In developed countries the incidence of operations for groin hernia is approximately 2000 operations per million population per year [2]. Nationwide information on the relation between the number of procedures performed per year and the rates of incidence of groin hernia have been more difficult to establish. However, the 1981/1982 morbidity statistics from general practice (third national study) estimated that approximately the same number of new hernias was diagnosed annually by general practitioners as the number of patients consulting their doctors with existing hernias [3]. This clearly suggests that a large number of groin hernias are not referred for definitive surgical treatment and that the prevalence is far higher than the annual incidence of operation. A survey in Somerset and Avon Health Authority in the UK of a stratified random sample of 28,000 adults aged over 35 enquired about lumps in the groin and invited those indicating positive replies to attend for interview and examination. The results revealed that of the hernias discovered, one third of patients had not consulted their primary care physician and of the two thirds that had seen their primary care physician, less than half had been referred to a surgeon for a decision on definitive management. Interestingly of the third of patients who had not consulted their general practitioner, two thirds said they would accept an operation if this was advised. Of the patients who eventually reached a surgeon, 20% were advised that operation was not required. These findings suggest that there is an unmet need for groin hernia surgery with many patients being denied access by their family doctor. Once referred, surgeons seem to act as gatekeepers and may indeed “cherry-pick.” Finally, there certainly appears to be a need for patient education in terms of the potential dangers of having a groin lump. Nevertheless, it is estimated that the number of groin herniorrhaphies done worldwide annually exceeds 20 million [4] and the lifetime risk of groin hernia is 27% for men and 3% for women [5].

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